We recently asked you – our readers – to weigh in on the difficulties of smoking cessation. What's stopping you from breaking one of the toughest bad habits? Read on to see if our M.D. answered your question...
From Chantix and Wellbutrin to the patch and electronic cigarettes, smokers have many ways to stop lighting up.
If you’ve been smoking for a long time, quitting is even more difficult, says Keith Heinzerling, M.D., assistant Clinical Professor in the Department of Family Medicine at UCLA.
“What makes you think in eight weeks you’re going to be able to undo that habit?” he says. “Hopefully it won’t take 25 years, but it might take a while to fix something that’s been digging a hole in your brain for the past 25 years.”
Most importantly, you have to want a successful outcome.
“You have to be committed and stick with it," he says. "If that’s not there, medications don’t work.”
In this exclusive, Heinzerling answers questions Facebook fans asked about ways to stay smoke-free and get started on new, healthier lives.
Cheryl asks: What over-the-counter medications help people curb the smoking habit?
There are three over-the-counter medications that are nicotine replacement products: the patch, nicotine gum and lozenges.
You chew on the gum and then park it between your cheek and gum like chewing tobacco. The nicotine is absorbed through your cheek.
The lozenge, you don’t have to chew. It’s a hard candy you suck on and the nicotine is absorbed through your cheek.
The two nicotine replacement [products] that require a doctor’s prescription are the nicotine nasal spray and nicotine inhaler.
Candy says: Chantix helped me quit, but I couldn’t afford it after the first month and started back. Are there more affordable medications?
Chantix is a bit more expensive than generic Wellbutrin or nicotine replacement.
There’s no generic for Chantix.
But it does seem to work a bit better [in helping people quit smoking].
It might be worth the extra [expense] for insurance companies or government because, if someone quits smoking, they may not have a heart attack or a stroke down the line, which costs a fortune in terms of medical care and loss of life and productivity.
Gail says: I’ve heard Chantix works great, but I've also heard it can cause depression with suicidal thoughts. I'm clinically depressed and doing wonderfully, but would like to quit smoking. I'm told that Chantix isn’t the drug for me due to my depression. What’s my best option?
There are alternatives, including Wellbutrin, which might also help someone with depression.
Or nicotine replacement, which has been around for about 40 years and don’t seem to have as big an issue [with side effects] as Chantix.
Jessica writes: My husband and I have been on Chantix for several months, and it has worked. But we're down to about one-half pack each and that seems to be our security blanket. Is there a fail-safe way to solve this problem?
It can be very, very hard [to quit], even if you’re using [nicotine] gum and lozenges as needed.
People end up taking a puff of a cigarette or having one, and then they throw in the towel believing they’ve failed.
That isn't necessarily a sign of failure.
So pick a date [to quit]. The package instructions with nicotine patches tell you to do this.
Going from 40 cigarettes to zero in one day sounds like a pretty big [task]. Patients have tried tapering down from 40 cigarettes to 18 and they just can’t do it.
So, plan a date to be your day to start [being smoke-free] for real.
Start the nicotine patch or prescription medications on that day.
For the first three weeks, try to smoke as little as possible, but don’t stress out.
If you end up going from 40 cigarettes to 18, great!
Then three weeks later, recalibrate and set another date and go for zero.
Shira asks: I'm trying to switch over to electronic cigarettes. Do they work?
Electronic cigarettes are just a better working nicotine inhaler.
It’s [a way] to get nicotine into your lungs and blood to your brain without burning tobacco and adding all the harmful stuff in tobacco smoke.
Nicole wants to know: Electronic cigarettes contain nicotine, so is it a safe way to detour from smoking?
There are a million cancer-causing and potentially heart-attack causing compounds in cigarette smoke that aren’t nicotine.
That doesn’t mean that nicotine is harmless.
Is nicotine what causes cancer and heart attacks? It’s hard to know for sure.
I can’t say that nicotine is 100% safe. Some data suggests that nicotine may be part of why people get lung cancer when they smoke.
It’s also safe to say the fumes from burning tobacco are toxic.
There may be some safety advantage to the electronic cigarette over a regular one, but that’s not based on any science.
If the patients are adults, they have to make their own decisions. But kids should definitely not be using electronic cigarettes or smoking at all.
Carol asks: Does the patch help you quit smoking?
The patch delivers nicotine through the skin.
Not only is the nicotine patch usually very safe, but the net benefit of going from the harm of cigarettes to the nicotine patch is massive.
Karen writes: Do prescription nasal sprays and inhalers work?
The nasal spray is absorbed through the nose and the inhaler was designed to approximate smoking.
It looks like an asthma inhaler, but you puff on it like a pipe, and nicotine gets aerosolized and goes down into your lungs.
Those are all just different ways to get around the fact that there is no nicotine pill.
Sue wants to know: Is there withdrawal from nicotine-replacement medications?
People using nicotine replacement [need to] taper down for [the same amount of time that they've been] using it.
They would experience withdrawal if they abruptly discontinued the nicotine patch or gum from a relatively high dose.
Judy says: Years ago, my dad was advised to stop smoking, and his doctor advised him to eat grapes [because] of a chemical in the grapes (does not matter what color, eat the seeds and all) that helped. How does it work?
I’ve never heard that. The chemical in grapes that everyone is interested in [is resveratrol], which is thought to be one of the benefits of red wine.
There’s some evidence that it might be beneficial for cardiovascular help, but honestly, I’ve never heard that [it helps with smoking cessation].
Lillian writes: I want to stop smoking, but am afraid of gaining weight. Is there a way to avoid that?
Nicotine is an appetite suppressant, so it’s hard to quit smoking without your appetite increasing.
People need to replace cigarettes with something else.
In the short run, medication might be the replacement.
But changes also need to be behavioral.
Try to substitute cigarettes with something healthy.
But you have to guard against just snacking because that adds fuel to the fire.
If you take nicotine replacement or Wellbutrin, studies show that you don’t gain as much weight [as without medication].
There isn’t data about Chantix yet, but [most experts] think it’s probably the same.
Using a medication can delay weight gain, but it doesn’t solve the problem.
Melissa wonders: Is it harder to quit if you drink a lot of caffeinated coffee?
Coffee and cigarettes can be linked, but there’s no pharmacologic association between caffeine intake and being able to quit.
If you get up every morning and have your cup of coffee and cigarette, then it’s harder.
Does that mean that you have to quit coffee? No.
But it means that you need to identify – whether it’s smoking or any substance for that matter – what triggers the [urge to smoke].
Kristen writes: What if I put a rubber band on my wrist and snap it every time I want a cigarette. Would that work?
It sounds crazy, but I tell people to put rubber bands around their wrists.
Every time you want a cigarette, touch it. Or every time you see it, it will remind you that you’re committed to not smoking.
The technique has not been studied in clinical trials, but there's no downside to putting a rubber band around your wrist.
We generally try to avoid using punishment too much [because] there have been mixed results.
Mary asks: Does hypnotism work?
There are reasons to believe it works.
Unfortunately, it seems to work in one study and not in another, so it might work in some people and not in others.
Lynn wonders: Is it true that three days after quitting, nicotine disappears from your system and, after that, it’s simply a habit?
It lasts several days.
That’s why when people try to quit cold turkey, the first day they’re usually kind of OK.
But the second, third and fourth days are when the nicotine is going away, their bodies and brains are saying, “What the heck? Where's the nicotine?”
Pat: Does lifestyle have an effect on the success rate of cessation?
For sure. We all have our routines, right?
You need to retrain yourself to do the things you did and not have the cigarette.
After a while, the brain says, “OK, I guess we do this without cigarettes.”
But, it takes a while.
Doctors prescribe medication, but many times we do a lot of pep talking.
Keeping them in the game in the long run is important because it often takes multiple tries [to quit smoking].
I tell them, “You’ve been smoking for 25 years. What makes you think in eight weeks you’re going to be able to undo that habit?”
Hopefully it won’t take 25 years to quit, but it might take a while to fix something that’s been digging a hole in your brain for that long.
For more information, visit our Smoking Cessation Health Center.
Are You Ready to Quit Smoking?
By now you should know that smoking increases your risk for heart disease, lung cancer, stroke and more. You know you should quit, but do you have a clear plan for overcoming your addiction?
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